What the EDS request is for
Exception Drug Status covers certain drugs under Manitoba’s Pharmacare program and the other provincial drug programs when their use meets specific criteria recommended by the Manitoba Drug Standards and Therapeutics Committee. These drugs used to be called Part 3 benefits. When an EDS drug is approved, Pharmacare covers it for the authorized period, after the patient’s Pharmacare deductible is met. If the request isn’t approved, the patient pays the full cost.
Use this general form for any EDS drug that doesn’t have its own form. Manitoba publishes drug-specific request forms for many products, including the oral anti-diabetic medications, and each lists the criteria on the form. Some private insurers also want EDS approval before they’ll cover a drug, so patients with private plans may ask for one too.
Who completes it
The prescriber completes and signs the whole form. There’s no patient section. You confirm on the form that you’ve told the patient their information is being released to Manitoba Health to obtain EDS coverage.
How to fill it in
Prescriber and patient
Enter your name, address, phone, fax, and licence number. The form asks for the licence number, not the billing number. For the patient, give their name, date of birth, PHIN, and Manitoba Health registration number (MHSC).
The drug and the request type
Mark a new request or a renewal. Give the medication, strength, and dosage form, the regimen and expected duration, and the diagnosis and indication. The EDS criteria notice lists the indication each drug is covered for, so use the same terms.
Treatment history
List each drug tried for the condition with its dosing regimen, start and end dates, and outcome: ineffective, intolerance, contraindication, or other. Many criteria in the EDS notice depend on earlier treatment, such as inadequate control on metformin and a sulfonylurea for several diabetes drugs. Give real dates and doses from the medication history.
Relevant clinical information
Add the findings the criteria ask for, such as lab values, scores, specialist involvement, or a diagnosis confirmed by a specialist. Manitoba Health can ask for more documentation, and a request still incomplete 30 days after it asks is cancelled.
Consent and signature
Check the box confirming you discussed the release of information with the patient, then date and sign.
Common reasons it’s delayed
- A billing number in place of the licence number.
- No treatment history, or trials listed without dates, doses, or outcomes.
- An indication that doesn’t match the drug’s EDS criteria.
- A drug-specific form exists but the general form was used.
- The prescription filled before approval, which EDS won’t cover.
- Requested information not sent within 30 days.
Submitting and who pays
Fax the completed form to the EDS office at (204) 942-2030 or 1-877-208-3588, numbers reserved for health professionals, or send it by mail. Manitoba triages requests by urgency and drug type. Coverage, once approved, starts from the date the EDS office received the request, so send it before the patient fills the prescription. If the request isn’t approved, the patient pays the full cost of the drug.